Development and delivery of the rehabilitation interventions for older adults with an ankle fracture in the AFTER (Ankle Fracture Treatment Enhancing Rehabilitation) trial

Journal article

Objectives
Describe the development and delivery of the interventions in the Ankle Fracture Treatment Enhancing Rehabilitation (AFTER) trial, a randomised controlled trial comparing the effectiveness of supervised versus self-directed rehabilitation for adults aged ≥50 years with an ankle fracture.
Design
Intervention development.
Setting
UK National Health Service (NHS) hospitals.
Method
We developed the interventions in stages. First, we reviewed two UK clinical guidelines and the existing research evidence. We then conducted a clinical practice survey (n = 59 physiotherapists) to inform a stakeholder meeting which identified key intervention components. Subsequently, we designed the interventions, tested them in a pilot trial (n = 61 participants), then refined them for the definitive AFTER trial.
Results/findings
The definitive AFTER trial interventions start after randomisation, which occurs when the participant’s cast/boot is removed and weightbearing and ankle movement restrictions are lifted. Participants allocated to self-directed rehabilitation receive a high-quality advice workbook, a progressively challenging self-directed exercise programme that they follow to self-manage their recovery, and strategies to encourage exercise adherence. Supervised rehabilitation participants receive a high-quality workbook, then 4 to 6 one-to-one face-to-face/remote sessions with a physiotherapist. The physiotherapist provides specific advice, home exercises, and uses strategies to facilitate adherence to prescribed exercises. The supervised rehabilitation intervention is tailored to individual participants during review sessions.
Conclusions
The definitive AFTER trial will provide high-quality evidence to guide rehabilitation provision for older adults with an ankle fracture. Results are anticipated in 2025.
Trial Registration Number
ISRCTN registry (identifier: ISRCTN11830323).

Authors: Forde, CP; Costa, ML; Achten, J; Grant, R; Lamb, SE

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Physiotherapy
• Volume: 128
• Article number: 101789
• Publication date: 2025-03-24
• Acceptance date: 2025-03-18
• DOI: 10.1016/j.physio.2025.101789
• EISSN: 1873-1465
• ISSN: 0031-9406
• Language: English